Suture granuloma

Last revised by Daniel J Bell on 31 Aug 2022

Suture granulomas, also known as Schloffer tumors, are localized inflammatory reactions in response to retained suture material. A similar process may also occur in certain situations with mesh repairs 5. Ultrasound is often used as a first-line imaging modality. It may be confused with a tumor or a recurrent tumor after surgery and should be considered in the differential in the correct setting.

Suture granuloma usually develops slowly after an intervention. It may become a palpable and tender mass, mimicking tumor or recurrent tumor.

A suture granuloma represents a benign granulomatous proliferation in response to a retained foreign body. They less commonly occur with absorbable sutures, but may still occur.

Obtaining a history of prior surgery with a surgical approach around the area of concern is important. Suture granulomas can present in the neck after thyroidectomy, mimicking recurrence 4.

High-frequency (>10 MHz) linear probe is useful.

  • hypoechoic collection
  • a small hyperechoic structure in the collection (the suture) is highly specific
    • often has parallel hyperechoic 'rail-like' morphology
  • may show mild vascularity on color Doppler 
  • suture granulomas may be FDG avid, mimicking neoplasm 2,3

The treatment of choice is resection of the retained suture and surrounding inflammatory tissue.

Schloffer's tumors are named after Hermann Schloffer (1868-1937), an Austrian surgeon who unusually was both a pre-eminent neurosurgeon and abdominal surgeon. He is most famous for performing the first successful transsphenoidal hypophysectomy on a living patient in 1907 6.

General imaging differential considerations include

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